Health insurance enrollment trends
Pro Research Analysisby 
Searched over 200M research papers
Health Insurance Enrollment Trends: Global and U.S. Perspectives
U.S. Health Insurance Enrollment Trends and the Affordable Care Act
Between 2013 and 2015, the implementation of the Affordable Care Act (ACA) led to a significant net increase in health insurance coverage in the United States, with 22.8 million people gaining coverage and 5.9 million losing it, resulting in a net gain of 16.9 million insured individuals . Over the longer term, from 2015 to 2022, private health insurance enrollment through the ACA Marketplace showed nuanced trends. After the repeal of the individual mandate in 2019, Marketplace enrollment actually increased by 1.4 percentage points, especially among vulnerable populations such as younger adults, racial minorities, and those with unfavorable social determinants of health. This growth was likely influenced by expanded enrollment windows, increased subsidies, enhanced outreach, and streamlined applications, particularly in response to the COVID-19 pandemic .
Employer-Sponsored and High-Deductible Health Plan Enrollment
From 2015 to 2021, the share of employer-sponsored health insurance enrollment in self-funded plans grew from 55% to 60%, with most states and counties experiencing this growth . High-deductible health plans (HDHPs) also saw increased enrollment among people under 65 with private insurance, rising from 40.3% in 2019 to 43.3% in 2021, before a slight decrease to 41.7% in 2023. Enrollment in HDHPs was higher among White non-Hispanic individuals, those with higher income and education, and those with employment-based coverage .
Nongroup and Veteran Health Insurance Enrollment
For Americans aged 50 to 64, about 9% purchase health insurance in the nongroup (individual) market, with the ACA improving access and affordability through the establishment of health insurance marketplaces and financial assistance . Among U.S. veterans, insurance enrollment increased from 94% in 2010 to 97% in 2020, with about one-third enrolled in VA health coverage. Most veterans with VA insurance also had another form of coverage, such as Medicare or private insurance. VA insurance enrollment was more common among those with lower income and poorer health status .
Health Insurance Enrollment Trends in Low- and Middle-Income Countries
In Ghana, enrollment in the National Health Insurance Scheme (NHIS) increased from 33% in 2010 to 41% in 2015, but then declined to 35% in 2017. Urban regions and informal sector workers had higher enrollment rates, but overall, renewal rates and new enrollments have been declining, highlighting the need for innovative strategies to boost participation . In Ethiopia, community-based health insurance schemes showed non-linear trends with both positive and negative growth rates, but overall negative growth ratios indicated challenges in sustainability. Key barriers included healthcare quality, claims reimbursement, governance, and community awareness .
A broader review across low- and middle-income countries found that health insurance schemes often fail to reach the poorest and least educated populations. On average, wealthier and more educated households had significantly higher odds of enrollment, suggesting that current schemes predominantly benefit better-off groups rather than the most vulnerable .
Accuracy of Health Insurance Enrollment Data
Survey data on health insurance enrollment generally align well with actual enrollment records, especially for employer-sponsored insurance. However, accuracy is lower for other types of coverage, such as marketplace plans, indicating the need for careful interpretation of survey-based enrollment statistics .
Conclusion
Health insurance enrollment trends reveal both progress and persistent challenges. In the U.S., policy changes have expanded coverage, especially for vulnerable groups, but disparities remain in plan types and access. In low- and middle-income countries, enrollment growth is uneven and often fails to reach the most disadvantaged populations. Addressing these gaps requires targeted policy interventions, improved outreach, and innovative enrollment strategies to ensure broader and more equitable health insurance coverage worldwide.
Sources and full results
Most relevant research papers on this topic
Trends and characteristics of enrolment in the National Health Insurance Scheme in Ghana: a quantitative analysis of longitudinal data
Enrolment in Ghana's National Health Insurance Scheme (NHIS) is declining, with significant differences among geographical regions and member groups.
Equity in health insurance schemes enrollment in low and middle-income countries: A systematic review and meta-analysis
Health insurance schemes in low- and middle-income countries are generally not reaching targeted underserved populations and predominantly supporting better-off population groups.
Enrollment Trends In Self-Funded Employer-Sponsored Insurance, 2015 And 2021.
Self-funded employer-sponsored health insurance enrollment grew from 55% in 2015 to 60% in 2021, with growth spread across most states and counties, and significant differences in plan types.
Enrollment and Coverage Trends for Americans Ages 50 to 64 in the Nongroup Health Insurance Market
The Affordable Care Act has improved health insurance coverage for Americans aged 50-64, with 5.6 million purchasing coverage through the nongroup market in 2014, compared to 3.8 million in 2011.
DOI